NM Insurance Update. Leadership Albuquerque. Linda Wedeen Interim CEO 12/21/2016

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1 NM Insurance Update Leadership Albuquerque 12/21/2016 Linda Wedeen Interim CEO

2 National Health Insurance Scene 2

3 ~80% of population covered through their employer, Medicaid or Medicare. The rest get insurance individually. Nationally as of fall 2016, 8% are still uninsured Even though insurance rates continue to increase, they have slowed down due the ACA. 3

4 New Mexico Insurance Scene 4

5 NM Uninsured Rate National New Mexico

6 Uninsured by County 35% 30% 25% 20% 15% 10% 5% 0% Bernalillo County Dona Ana Couty Santa Fe County Sandoval County San Juan County County Uninsured Anglo Latino % of NM Population 6

7 : New Mexico s Health Insurance Exchange BeWellNM s mission is to enroll all qualified New Mexicans in the New Mexico Health Insurance Exchange thereby improving the collective health and well being of New Mexicans by facilitating better access to competitive, affordable, highquality, timely medical care through greater healthcare coverage. 7

8 The BeWellNM Marketplace New Mexicans can shop, compare and buy a plan that is right for them by making apples-to-apples comparisons between affordable health plans and determining their eligibility for cost-savings. Coverage for Individuals & Families For New Mexicans who: Are uninsured or have no access to coverage through their employer Currently buy insurance on their own New Mexico is borrowing federal technology to process enrollments for individuals and families. Coverage for Small Businesses For employers with 2-50 employees needing small group plan options BeWellNM runs the Small Business Health Options (SHOP) Marketplace Open Enrollment for the SHOP is on-going Employers can enroll at any time! 8

9 ACA Impact 2016 Marketplace selections 54,865 Marketplace enrollees with financial assistance Medicaid and CHIP enrollment. Dec 1, 2016 More than 300k due to expansion 70% 888,447 9

10 Top 5 Qualified Plan Benefits Exchanges are the only place where New Mexicans can get financial assistance for health insurance. Nobody can be denied coverage for pre-existing health conditions; health status is not a factor (can t be denied or charged more for health status, except smoking) and there are no health questions as part of application. All plans cover doctor s visits, prescriptions, hospital stays, maternity care, tests and more. New Mexicans have a choice between popular health plans with easy to use comparison tools. Through BeWellNM, anyone can find free help from an Agent, Broker or Enrollment Counselor to help understand options and enroll. 10

11 The Exchange Marketplace has numerous plans for every family and budget Consumers can choose from 4 issuers in the individual Marketplace in 2017: Molina Christus St Vincent New Mexico Health Connections Blue Cross Blue Shield 11

12 The Individual Mandate Penalty If someone does not have coverage in 2017, they will pay the higher of these two amounts: 2.5% of your yearly household income. (Only the amount of income above the tax filing threshold, about $10,000 for an individual, is used to calculate the penalty.) The maximum penalty is the national average premium for a bronze plan. $695 per person in the family for the year It is possible that the penalty for having insurance could cost more than paying for insurance after the tax credit is applied! 12

13 Marketplace Affordability BeWellNM is the only place to get cost-savings that may help lower the monthly cost of health insurance. Advanced Premium Tax Credit (APTC) A tax credit that can help New Mexicans afford coverage bought through BeWellNM. These tax credits can be used right away to lower monthly premium costs. Requires the purchase of a plan through the Exchange. Cost Share Reductions (CSR) This term generally includes a reduction in deductibles, coinsurance, and copayments, or similar charges, but it doesn't include premiums, balance billing amounts for non-network providers, or the cost of non-covered services. Requires purchase of a Silver plan on the Exchange. 13

14 Protections for Native Americans There are Special Marketplace protections and benefits for American Indians and Alaska Natives: May be able to get lower premium costs based on income. Exempt from cost-sharing (co-pays, deductibles, co-insurance) if income is less than 300% FPL and enrolled in an Exchange plan. Exempt from cost-sharing at any Indian Health Service, Tribal health program, urban Indian health program (I/T/U) Special enrollment periods. Native Americans are allowed to enroll throughout the year. 14

15 How to Reach the Consumers 15

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17 Consumer Centric Enrollment Ecosystem Advertising (print, TV, Radio, Outdoor, Digital) Public Relations Social Media Native American Outreach Stakeholder Outreach Awareness Education Outreach Partners Events Call Center Website Agents & Brokers Enrollment Entities (native and non-native) Enrollment Entities Agents & Brokers Heathcare.gov Enrollment Retention Advertising Public Relations Social Media Carriers Agents & Brokers Enrollment Entities 17

18 Driving a Consumer Centric Enrollment Strategy Consumer Insights Market Research Enrollment Data Consumer Segmentation Consumer Behavior Data Campaign Strategy Messaging Creative Expression Channel Activation Public Relations Advertising Community Outreach Social Media Website Enrollment Consumer Decision Support Tools Agents & Brokers Enrollment Counselors Call Center 18

19 Questions? Thank You! 19